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only by being declared by the applicant. An essential part of the aviation medical examination is thus a
comprehensive medical history. This is usually facilitated by written questionnaire. The answers provided by
the applicant may lead to further questioning by the examiner. It is easily argued that this medical history is a
more critical component than the physical examination, and the examiner needs to be skilled at evaluating the
information which has, or has not, been provided. Evaluating medical history is a core clinical skill of any
medical practitioner, but in the aviation setting it is conducted and applied somewhat differently.
2.1.1 Question applicant on written history to elicit further detail on positive or omitted responses:
a) Explain the limitations of a written history questionnaire.
b) Describe process used to check for omissions.
c) Describe process for identifying key positive responses.
d) Describe process for enquiring further into key positive responses.
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e) List examples of key omitted responses.
f) List examples of key positive responses.
2.1.2 Question applicant on negative responses in written history which may be relevant (as indicated by
other responses):
a) Describe process for identifying key negative responses.
b) Describe process for enquiring further into key negative responses.
c) List examples of key negative responses.
2.1.3 Question further in accordance with the risk profile of the applicant:
a) Identify typical demographic and other factors which lead to risk of underlying conditions.
b) List examples of specific questions which would be appropriate for specific risk profiles.
2.1.4 Continually update mental picture of potentially important issues:
a) List examples of areas from history that may require particular attention during subsequent
examination.
b) Describe how to identify and prioritize these issues for subsequent examination.
c) Identify from a given medical history, the potentially important issues.
d) Demonstrate how to prioritize these issues with respect to flight safety risk.
2.2 Perform Examination
The systematic physical examination is, on its own, not highly effective as a means of detecting important
medical illness. However, as mentioned earlier, it may be the part of the medical assessment which is
accorded the greatest weight by applicants. This is useful as it is important as a means of verifying matters
raised in the history, and of conveying professionalism and trustworthiness.
2.2.1 Perform a systematic examination according to the requirements of the licensing authority:
a) Demonstrate how to find the licensing authority’s requirements for examination.
b) Explain the objectives, purposes and limitations of physical examination.
c) Describe a logical sequence of a full physical examination.
d) List processes used to avoid omissions.
e) Describe how the examination may be targeted to focus on specific systems or areas.
Much of the physical examination is routine and is part of the daily practice of all doctors. It should be
performed in a systematic and comprehensive manner, but with extra attention to target areas which may have
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been highlighted in the foregoing medical history. Additionally, certain components stand out in terms of
relevance to aviation safety and the frequency of problems, and therefore merit particular focus during the
examination, and these are outlined below.
2.2.2 Perform targeted examination as indicated:
a) Describe how the examination may be targeted based on the history findings.
b) Describe how the examination may be targeted based on general examination findings or observation
of the applicant
Consideration should again be made of the age and other demographic characteristics of the applicant; the
more likely issues for the current age group or profile should be given particular focus. ICAO has
recommended (2009) that States allow medical examiners to omit certain elements of the routine physical
examination of applicants aged under 40, in favour of concentrating on those items considered most relevant
to the risk profile of the applicant (Annex 1, para 6.3.1.2.1).
2.2.3 Focus examination on higher risk areas pertaining to incapacitation:
a) Identify aspects of the physical examination which may require particular attention with regard to
incapacitation risk.
b) Describe the process for carrying out these aspects of the examination.
As discussed earlier, most causes of incapacitation are more likely to be identified on the basis of medical
history than examination, however the examination of the cardiovascular system in particular may provide
　
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